{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:06Z","timestamp":1789711746866,"version":"4.0.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n The relationship between pre-procedural corrected QT (QTc) interval and in-hospital major adverse cardiovascular events (MACE) following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remains incompletely understood. This study evaluated the predictive value of pre-procedural QTc for in-hospital MACE.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This single-center retrospective cohort study consecutively enrolled AMI patients undergoing primary PCI. QTc intervals were manually measured from pre-procedural 12-lead electrocardiograms using the Bazett formula, with a prespecified sensitivity analysis using the Fridericia formula. Missing data sensitivity analyses (complete-case BNP model and multiple imputation, m\u2009=\u200920) confirmed that BNP adjustment did not alter the QTc effect. No formal sample size calculation was performed; findings are exploratory. The primary endpoint was in-hospital MACE (composite of ventricular arrhythmias, cardiogenic shock, acute heart failure, and bleeding complications). Logistic regression and receiver operating characteristic (ROC) analyses were performed.<\/jats:p>\n \n Among 123 patients (mean age 55.3\u2009\u00b1\u200911.9 years; 91.1% male), 53 (43.1%) experienced MACE. Prolonged QTc (&gt;440\u2005ms) was associated with MACE in univariate analysis (OR\u2009=\u20093.01, 95% CI: 1.41\u20136.39,\n P<\/jats:italic>\n \u2009=\u20090.004). After multivariate adjustment, reduced LVEF (OR\u2009=\u20090.76 per 5%,\n P<\/jats:italic>\n \u2009=\u20090.019) and elevated baseline heart rate (OR\u2009=\u20091.57 per 10 bpm,\n P<\/jats:italic>\n \u2009=\u20090.023) were independent predictors; continuous QTc was not (OR\u2009=\u20091.03 per 10\u2005ms,\n P<\/jats:italic>\n \u2009=\u20090.605). The model AUC was 0.767\n (<\/jats:bold>\n optimism-corrected AUC\u2009=\u20090.782; optimism\u2009=\u2009\u22120.014). Adding QTc to conventional risk factors yielded negligible incremental AUC (\n \u0394<\/jats:italic>\n \u2009=\u20090.001,\n P<\/jats:italic>\n \u2009=\u20090.888). A numerically high MACE rate was observed in the small subgroup with both LVEF &lt;40% and QTc &gt;440\u2005ms (9\/11, 81.8%; 95% CI: 48.2%\u201397.7%), but the LVEF\u2013QTc interaction was not statistically significant (\n P<\/jats:italic>\n \u2009=\u20090.941), precluding any conclusion of synergistic risk. A prespecified sensitivity analysis excluding isolated bleeding events (cardiovascular MACE\u2009=\u200940\/123, 32.5%) confirmed that LVEF remained independently predictive (OR\u2009=\u20090.73,\n P<\/jats:italic>\n \u2009=\u20090.008) while QTc showed no independent association (\n P<\/jats:italic>\n \u2009=\u20090.915) and no incremental value (\n \u0394<\/jats:italic>\n AUC\u2009=\u20090.000,\n P<\/jats:italic>\n \u2009=\u20090.772). A further sensitivity analysis using the Fridericia formula abolished the univariate QTc\u2013MACE association (OR\u2009=\u20091.23,\n P<\/jats:italic>\n \u2009=\u20090.615 vs. OR\u2009=\u20093.01,\n P<\/jats:italic>\n \u2009=\u20090.004 with Bazett), indicating that Bazett overcorrection at high heart rates contributed substantially to the apparent univariate signal. BNP adjustment (complete-case and multiple imputation) did not change the QTc coefficient (&gt;1% variation), indicating no residual BNP confounding.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Pre-procedural QTc prolongation is associated with in-hospital MACE but is not an independent predictor after adjustment for conventional risk factors, with limited incremental value (\n \u0394<\/jats:italic>\n AUC\u2009=\u20090.001). A numerically high MACE rate was noted among patients with both reduced LVEF and prolonged QTc, but this observation derives from only 11 patients with a nonsignificant interaction term (\n P<\/jats:italic>\n \u2009=\u20090.941); it should be regarded as exploratory and requires validation in larger prospective studies.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1952189","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:39:53Z","timestamp":1789709993000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of pre-procedural QTc interval for in-hospital major adverse cardiovascular events following primary percutaneous coronary intervention in acute myocardial infarction"],"prefix":"10.3389","volume":"13","author":[{"given":"Chunyan","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Function, Affiliated Xiaoshan Hospital, Hangzhou Normal University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong'er","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Function, Affiliated Xiaoshan Hospital, Hangzhou Normal University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1161\/01.CIR.84.4.1516","article-title":"QT Interval prolongation predicts cardiovascular mortality in an apparently healthy population","volume":"84","author":"Schouten","year":"1991","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment 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